PHARMACISTS AND STUDENT PHARMACISTS INVOLVEMENT IN DRUG ABUSE ISSUES

Patricia Darbishire, PharmD, RPh

Alexa Proctor, PharmD Candidate

Wesley Horner, PharmD Candidate

Purdue University College of Pharmacy

(Outline of Presentation…)

Background of project/purpose and what we hope to achieve

• Drug use in healthcare students compared to all college students

College/School of Pharmacy internal discussion on issue

Extrapolation of this study to nursing/medical schools

Pharmacy student perspective

• Stressors, competition, knowledge of medications, ease of access

Methods and design of research

Tentative results/trends and feedback received

• Comparative data with trends and demographics

Authors conclusions and future of drug screening

RESEARCH CONTRIBUTORS

Purdue University College of Pharmacy

o Patricia L. Darbishire, PharmD, RPh, Clinical Associate Professor of Pharmacy

Practice and Director of Introductory Pharmacy Practice Experiences

o Alexa J. Proctor, PharmD Candidate

o Wesley J. Horner, PharmD Candidate

Butler University College of Pharmacy and Health Sciences

o Patricia (Trish) Devine, PharmD, RPh, Associate Professor of Pharmacy Practice and

Director of Campus-Based Experiential Education

o Emily M. Hoffman, PharmD Student

Pacific University School of Pharmacy

o Jeremy Hughes, PharmD, Assistant Dean for Student Affairs and Assistant Professor

o David G. Fuentes, PharmD, BCPP, CGP, Assistant Dean for Academics and

Assessment

OBJECTIVES

o Describe drug diversion and addiction among pharmacy

students

o Identify pros and cons of drug screening students

o Assess Purdue University research and results

RESEARCH BACKGROUND

Purpose/objective of researcho Research is lacking on this subject and

o Researchers have suggested student substance abuse prevention, assistance,

and education be proactively addressed by colleges and schools of pharmacy

(https://www.ncbi.nlm.nih.gov/pubmed/21302181)

Who does this research impact?o School administrators

o Students

o Experiential site preceptors

o Patients

o Law enforcement

RESEARCH BACKGROUND

What we hope to achieve/goals:

o Protect the integrity of the profession

o Prevent student substance use/addiction

o Research has demonstrated several occupational risks for substance use

disorders among pharmacists:

o Increased access to prescription drugs

o Stressful work environment

o Lack of education regarding addiction

o Lack of support for individuals seeking treatment

(http://www.ncbi.nlm.nih.gov/pubmed/22825228)

DRUG USE IN HEALTHCARE STUDENTS

Research reports substance use among pharmacy students to be

associated with:

o Blackouts (18.2%)

o Attending class or work under the influence (7.8%)

o Providing patient care while under the influence (1.4%)

o Lowered grades or job evaluations (5.8%)

o Legal charges (2.7%)

o (https://www.ncbi.nlm.nih.gov/pubmed/21302181)

DRUG USE IN HEALTHCARE STUDENTS

Pharmacy students self-report substantial recreational drug use• marijuana (5.9%–28%)

• amphetamines (1.2%–6.8%)

• cocaine (0.5%–13%)

• sedatives (3%–9%)

• opioids (0.7%–5.1%) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779636/).

Medical students report recent substance use (within last 30 days)• alcohol (87.5%)

• marijuana (10%)

• cocaine (2.8%)

• tranquilizers (2.3%)

• opiates (1.1%)

EXTRAPOLATION OF RESEARCH DATA

• Potential cross-functional benefits for medical and nursing schools

• Address risks/concerns with this population to help solve the

problem

• Past year recreational drug use is reported by 9.4% of health care

students

• Allied health 8.4%, dental 10.2%, medicine 12%, nursing

8.6%, pharmacy 8.9% (http://www.ncbi.nlm.nih.gov/pubmed/17135178)

PHARMACY STUDENT PERSPECTIVE

Potential for inappropriate substance use due to:

o Competitiono Acceptance into pharmacy school, internships, job/post grad

training placement, etc.

o Stressorso Long work/study hours, heavy course load, peer pressure, etc.

o Knowledge of medicationso Effects, time stays in system, t1/2 of drugs, school policy specifics

PHARMACY STUDENT PERSPECTIVE

o High rates of drug abuse among college students is attributed to

stress, curiosity, peer pressure, and heavy course loads

(https://www.addictioncenter.com/college/)

o In 2013, the rate of current illicit drug use was 22.3% percent among

full-time college students aged 18 to 22 (http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresu

lts2013.pdf)

PURDUE UNIVERSITY RESEARCH

o Pharmacy students and faculty developed and designed a survey to

gather data on drug screening/testing policies and procedures, and

inappropriate substance use at colleges/schools of pharmacy

o Survey administered to 135 programs

o 129 ACPE accredited

o 6 ACPE candidate status

o Web-based and paper surveys were sent to professional program

deans, experiential learning, and student services/affairs personnel

STUDY RESULTS

o 73% survey response rate

o 98 out of 135 programs participated

REGIONAL DEMOGRAPHIC

• Drug screening% by region

• Map of US

• Preveleance

COMPARISON OF PROGRAM TYPES

COMPARISON OF SUBSTANCE USE INCIDENTS

• More programs that perform drug screens report 0 student substance

use incidents per year

COMPARISON OF SUBSTANCE USE INCIDENTS

o Programs that perform drug

screens also are aware of more

total substance use incidents per

year

o Drug screening could allow for

substance use incidents to be

both prevented and recognized

to provide proper treatment

SUBSTANCES USED

DRUG SCREEN OR NOT

Compare substance use data:

-Average incidents of screening schools vs. non

-Average incidents by demographic (rural, urban, etc)

STUDY TRENDS

• Majority of preceptors/sites not aware of student problems at risk

for student drug abuse at site and/or improper patient care• Notified of positive drug screen? Preceptors only 13%

SUBSTANCE USE PREVENTION

“In some situations, students

need a reason to say "no" and

this gives them that reason. It

also tells students that this

issue is important to us.”

“Students will be less likely

to use if they know they can

be screened at any time.

Non-random screens are

highly ineffective in

detecting use.”

“I would say yes and no. Students who

have a substance use disorder (addiction)

will likely find it difficult to abstain in spite

of potential consequences (which is what

defines addiction). Students who do not

have the disease of addiction and use

occasionally are more likely to abstain.”

SUBSTANCE USE PREVENTION

• Administrators have mixed views on whether drug screening would deter

students from inappropriate substance use

• “Only if it is truly random, frequent, comprehensive, and conducted in a quality manner.”

• “It is more effective at preventing students from starting, however, it is less effective for those who

are already abusing them.”

• “Screening reinforces the seriousness of the college's substance abuse policies. Some students

are not deterred, but some are, and it is worth the effort to deter those students.”

• Percent of yes and no

INITIAL MOTIVATION FOR DRUG SCREENING

Authors’ Conclusions

What does the data imply…

What is the future of drug screening/deterrence methods…